HomeMy WebLinkAboutCAG2020-381 - Insurance Certificate - Puget Sound Regional Fire Authority - Certificate of Coverage 12/01/2020-12/01/2021CIAW 2020-2021 Page 1
Issue Date: 11/20/2020 Cert#: 0000000586
CITIES INSURANCE ASSOCIATION OF WASHINGTON
CERTIFICATE OF COVERAGE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE MEMORANDUM OF COVERAGE (MOC) BELOW. THIS CERTIFICATE OF COVERAGE DOES
NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: IF THE CERTIFICATE HOLDER IS AN ADDITIONAL COVERED PARTY, THE MOC MUST BE ENDORSED. IF SUBROGATION IS WAIVED, SUBJECT TO
THE TERMS AND CONDITIONS OF THE MOC, CERTAIN COVERAGE MAY REQUIRE AN ENDORSEMENT. A STATEMENT ON THIS CERTIFICATE DOES NOT CONFER
RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENT(S).
PRODUCER COMPANIES AFFORDING COVERAGE
Clear Risk Solutions
451 Diamond Drive
Ephrata, WA 98823
Phone: (509) 754-2027 Fax: (509) 754-3406
COVERED MEMBER
Puget Sound Regional Fire Authority
24611 - 116th Avenue SE
Kent, WA 98030
GENERAL LIABILITY
CIAW / Old Republic Specialty Insurance Underwriters
AUTOMOBILE LIABILITY
CIAW / Old Republic Specialty Insurance Underwriters
PROPERTY
CIAW / Old Republic Specialty Insurance Underwriters et al.
CRIME / PUBLIC EMPLOYEE DISHONESTY
CIAW / Old Republic Specialty Insurance Underwriters
COVERAGES
THIS IS TO CERTIFY THAT THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE COVERED MEMBER NAMED ABOVE FOR THE COVERAGE PERIOD
INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED BY THE MOC DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS
AND CONDITIONS OF SUCH MOC. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE MOC NUMBER MOC EFF
DATE
MOC EXP
DATE
DESCRIPTION LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
OCCURRENCE FORM
CIAW202147269 12/01/2020 12/01/2021 GENERAL AGGREGATE $25,000,000
PRODUCT-CO MP/OP AGG $25,000,000
PERSONAL & ADV. INJURY $15,000,000
EACH OCCURRENCE $15,000,000
(LIABILITY IS SUBJECT TO A $100,000 SIR PAYABLE FROM PROGRAM FUNDS)ANNUAL PROGRAM AGGREGATE $50,000,000
AUTOMOBILE LIABILITY
ANY AUTO CIAW202147269 12/01/2020 12/01/2021 COMBINED SINGLE LIMIT $15,000,000
(LIABILITY IS SUBJECT TO A $100,000 SIR PAYABLE FROM PROGRAM FUNDS)ANNUAL PROGRAM AGGREGATE NONE
PROPERTY
CIAW202147269 12/01/2020 12/01/2021 ALL RISK PER OCC EXCL EQ & FL $100,000,000
EARTHQUAKE PER OCC $15,000,000
FLOOD PER OCC (except FZ A&V, which is
$1MM)
$15,000,000
(PROPERTY IS SUBJECT TO A $100,000 SIR PAYABLE FROM PROGRAM FUNDS)ANNUAL PROGRAM AGGREGATE NONE
CRIME/PUBLIC EMPLOYEE DISHONESTY
CIAW202147269 12/01/2020 12/01/2021 PER LOSS $1,000,000
(CRIME IS SUBJECT TO A $25,000 PROGRAM SIR)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / SPECIAL ITEMS
Regarding Emergency Management Performance Grant, Grant Agreement Number E18-099. City of Kent is named as Additional Covered Party regarding this Agreement
only and is subject to coverage terms, conditions, and exclusions. Additional Covered Party endorsement is attached. The MOC is primary and non-contributory. Waiver of
Tranfer Subrogation is attached. Seperation of Named Insured endorsement is included in the policy.
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED COVERAGE BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE MOC PROVISIONS.
CERTIFICATE HOLDER AUTHORIZED REPRESENTATIVE
City of Kent
220 Fourth Avenue South
Kent, WA 98032
CIAW 2020-2021 Page 2
WAIVER OF TRANSFER OF RIGHTS AND RECOVERY AGAINST OTHERS TO US
THIS ENDORSEMENT MODIFIES COVERAGE PROVIDED UNDER THE FOLLOWING:
GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Kent
220 Fourth Avenue South
Kent, WA 98032
Any person or organization as shown in the Schedule above, for whom we make a payment under this coverage,
must transfer their right to recovery against any other party. After a Claim they must do everything necessary to
secure, and nothing to impair these rights. However, we will waive our right of recovery against any person or
organization as shown in the Schedule above with respect to which the Covered Party has waived its right of
recovery prior to the Occurrence, Accident, or Wrongful Act in a Covered Contract.
All other terms and conditions remain unchanged.
CIAW 2020-2021 Page 3
ADDITIONAL COVERED PARTY ENDORSEMENT
THIS ENDORSEMENT MODIFIES COVERAGE PROVIDED UNDER THE FOLLOWING: GENERAL LIABILITY
COVERAGE PART
How coverage is changed:
It is agreed that the interest of any Additional Covered Party is recognized as their interests may appear, providing
the certificate of coverage that this is attached to has been issued and is on file with the Company.
The Limits of Coverage applicable to the Additional Covered Party are those specified in either the:
1. Written contract or written agreement; or
2. Declarations for this MOC, whichever is less.
These Limits of Coverage are inclusive and not in addition to the Limits of Coverage shown in the Declarations.
All other terms and conditions remain unchanged.
Additional Covered Party:
City of Kent
220 Fourth Avenue South
Kent, WA 98032
Regarding Emergency Management Performance Grant, Grant Agreement Number E18-099. City of Kent is
named as Additional Covered Party regarding this Agreement only and is subject to coverage terms,
conditions, and exclusions. Additional Covered Party endorsement is attached. The MOC is primary and non-
contributory. Waiver of Tranfer Subrogation is attached. Seperation of Named Insured endorsement is
included in the policy.